Presence of Embolic Source and Outcome in Central Retinal Artery Occlusion

Abstract

Objectives:The etiology of central retinal artery occlusion (CRAO) is unclear in about 50% of patients, suggesting pathomechanical heterogeneity; moreover, little is known about outcomes according to etiology. This study investigated whether the presence of an embolic source affects outcome in CRAO.Methods:CRAO patients within 7 days of symptom onset were retrospectively enrolled. Clinical parameters, including initial and 1-month visual acuity, CRAO subtype, and brain images, were reviewed. CRAO etiology was categorized as CRAO with or without an embolic source (CRAO-E+and CRAO-E-). Visual improvement was defined as a decrease in logarithm of the minimum angle of resolution ≥0.3 at 1 month.Results:A total of 114 patients with CRAO were included. Visual improvement was noted in 40.4% of patients. Embolic sources were identified in 55.3% of patients, and visual improvement group rather than no improvement group was more commonly associated with the presence of an embolic source. In multivariable logistic regression analysis, CRAO-E+independently predicted visual improvement (OR 3.00, 95% CI 1.15–7.81,P= 0.025).Discussion:CRAO-E+was found to be associated with a better outcome. CRAO-E+may be more prone to recanalization than that CRAO-E-.

Clinical characteristics of recurrent non-arteritic retinal artery occlusion

“…The primary causes of CRAO are cardioembolisms and artery-to-artery embolisms of the carotid artery; however, approximately half of all CRAO cases are due to an unknown aetiology, which is much higher than the proportion of stroke cases with unknown causes. 17 Differences in cerebrovascular and cardiovascular factors between patients with recurrence in the same eye and those with recurrence in the opposite eye may suggest variations in the thromboembolic risk associated with recurrent RAO. 18 19 This implies that although the patients did not have any obvious cerebrovascular abnormalities, and had a low likelihood of systemic vascular disease, there was still a possibility of RAO recurrence.…”

“…Considering the association between RAO and embolic sources from the heart, 17 it is crucial to perform cardiac evaluations, such as coronary angiography and transthoracic echocardiography, in addition to brain imaging, especially in high-risk patients. Previous studies have shown that approximately 50% of patients with non-arteritic CRAO have abnormal echocardiographic findings, indicating an embolic source.…”

“…Given that RAO is associated with a very high risk of cerebrovascular and cardiovascular complications, the recurrence of RAO may be viewed as a subsequent stroke event that increases the likelihood of morbidity and mortality. [22][23][24][25][26] Considering the association between RAO and embolic sources from the heart, 17 it is crucial to perform cardiac evaluations, such as coronary angiography and transthoracic echocardiography, in addition to brain imaging, especially in high-risk patients. Previous studies have shown that approximately 50% of patients with non-arteritic CRAO have abnormal echocardiographic findings, indicating an embolic source.…”

Circulating serum fibroblast growth factor 21 as risk and prognostic biomarker of retinal artery occlusion

“…Additionally, for low vision categories such as "counting fingers", "hand motion", "light perception" and "no light perception," corresponding logMAR values were determined as 2.0, 2.3, 2.6, and 2.9 respectively 20 . A favorable visual outcome was defined as a significant improvement in visual acuity, characterized by a reduction of 0.3 or more in logMAR 21 .…”